Saturday, February 25, 2012

One year we returned from vacation a day early, because of a problem with one of our dogs. My parents had taken him to the vet for us, and Mrs. Grumpy wanted to rush home and get him (he was her baby).

The vet's office was closed for the weekend when we got back, but they'd told us the 20-something girl who stayed with the pets overnight would let us in to get Fido, since it was a special circumstance and we were established clients.

Anyway, we came by, and she let me in to get the dog. I had some questions, and was talking to her in the lobby for a few minutes. Her shirt was on inside-out, but I didn't pay much attention to it until a naked guy came wandering out of the back and said, "Hey, don't leave me hanging... Oh, sorry" and ran back.

Friday, February 24, 2012

A while back I was called to the hospital to see a guy with a stroke affecting his language cortex. He wasn't able to talk at all. He didn't have any weakness or other issues, just couldn't speak.

It was a pretty notable stroke on MRI. I spent some time talking to his wife, then went home.

The next day I was absolutely shocked when I was on rounds, and he got in the elevator with me! He looked great, was dressed in his street clothes, and I began talking to him. His speech was excellent. It was the most remarkable recovery I'd ever seen in such a a short time.

That doesn't mean I don't vote for President- I always do. And almost every other election that comes up.

Every political system has it's quirks. And this one is a real pet peeve of mine.

To give some background for my non-U.S. readers:

The American political system started, like most, in an era when horses were the main method of transportation, and hence long-distance communication of news. So it wasn't practical to count every single nationwide vote in Presidential elections every 4 years (there were other issues for the electoral college, but I'll let commentators fill those in).

Each U.S. state was given a certain number of votes in an electoral college, based on how many congressional representatives it has. In this system, whichever candidate gets > 50% of the vote in a state gets ALL that state's electoral college votes. It's all-or-nothing. To be fair, a few states have tried to remedy this, by splitting up electoral votes by districts, or based on percentages of popular votes. But for most, it's still all-or-nothing.

So 3 times in American history the winner of a Presidential election was NOT the person who won the majority of the popular vote.

Now, in an era where you had to tabulate votes locally, and send the results by horseback, this system made sense. But with the invention of the telegraph, and then the radio, telephone, and internet, it's not needed. The technology is now there to count every vote, which certainly would be fairer.

So, since Dr. Grumpy lives in a state where he's in the political minority, his Presidential vote is meaningless. All my state's electoral votes go to the other side.

The practical result of this is that, out of the 50 U.S. states, only 10 or so really are the ones that elect a President. They call them "swing states", where they have a large number of electoral votes AND a population that's fairly evenly split. And so politicians only focus on kissing ass in those areas, and ignore the other 80% of us.

Now, most Americans hate this crap. Polls taken regularly since 1944 have shown that a large majority of Americans want to toss the electoral college and just go to direct election by popular vote.

Has this ever even come close to happening? Hell no. Why not, you ask?

Because it's not in the best interest of any major political party!

Let's look at this: Say I'm Humungous Political Party, trying to get my bozo elected. I have a finite amount of money to blow on TV ads, public rallies, etc. Say, (for simplicity) it's $100.

In the current system I can focus that $100 on the 10 states where it matters (at $10/state), and ignore the rest of the voting peons all over the country.

But, if the electoral college were gone, then every single vote, from populous New York to rural Alaska, becomes equal. I'd have to spread my resources thin and blow only $2/state trying to reach everyone with a ballot.

No political party wants to do that. They want to focus their dollars on a concentrated area, getting the most returns for their spending.

You can write to your congressman all you want. He'll agree with you, then vote the opposite way. Multiple attempts to change this have been introduced, and all were killed off early.

"Doctor, I really want to know if I have something. Because if it's anything, it would probably be something. And I want to know if it's something. If it's nothing, then that's not anything, but I need to know if it's anything like something or nothing."

Sermo is one of many online medical communities. I tried it a few years back, but deleted my membership out of boredom. I'd never written any posts, and got tired of the daily emails on such controversial topics as "doctors should provide patient care," "we all want to make more money," and "hospitals are for sick people."

Anyway, apparently they've livened things up (or it was online sweeps week) because my reader Sally sent in this headline, which was a "Sermo Pick" last week (on Valentine's Day, no less):

(click to enlarge)

This was, actually, a tragic story. A married doctor (Hyo Shin, age 64) had been having an 18-month affair with Sarah Garibay (age 29) a lady he met at a strip bar, and became her "sugar daddy". He died after her other sugar daddy (Jeff Clay, age 49) walked in on them at an inopportune time and beat Dr. Shin. The doctor then jumped out a window to escape, and eventually died from his injuries. Clay has been sentenced to 12 years for voluntary manslaughter.

In a surprising twist, the late Dr. Shin's wife told the court that her husband had "a high moral standard and would not stand for one speck of immorality."

The wife of the convicted Mr. Clay testified that he was "hard-working and non-violent", and that she still wanted him to come back to her even though he'd been seeing 2 other women and using methamphetamine.

Another story noted that Miss Garibay (who denied being a prostitute) testified in court while "wearing a short skirt and low-cut top." She said she "immensely" loved her married boyfriend Clay, and was "hurt" that he subsequently tried to hire a prison inmate to kill her, too.

Anyway, I asked some of my colleagues about their takes on this story, and they had a few pointers:

Sunday, February 19, 2012

Today, February 19, 2012, marks the 67th anniversary of the Marines' landing on the island of Iwo Jima. 70,000 U.S. Marines and support troops went ashore against 22,060 entrenched Japanese.

On March 26, 1945, when the island was declared secured, 6,812 Americans (10%) were dead or missing, and an additional 19,217 (27%) had been wounded. Of the defending Japanese force, only 217 were captured. The remaining 21,844 (99%) were killed.

27 Medals of Honor were awarded (13 posthumously) - over one-fourth of all the MOHs awarded to Marines in all of WWII.

I recently had the honor of meeting an Iwo Jima survivor at an assisted living facility. He summed it up this way: "The Japs would not surrender. They wouldn't come out of their caves. So, we burned them out with our flamethrowers, then shot them with our rifles. It was awful".

The picture I've included is not the one you might expect - the flag-raising on Mt. Suribachi. Rather, it is a landing craft of "average" Marines, most in their 20's, throwing themselves into the raging inferno, despite their fears and trepidations. Home must have seemed like a distant planet. We owe them everything.

It wasn't meant to get any sort of attention, I just needed to come up with a disease name.

To my surprise, my stats have since shown a surprising number of people googling "Hufnagel's Syndrome" trying to find out what it was, then being directed back to the post. I've also received about 20 emails asking about it.

So here is the answer: There is no such disease.

The name idea is from a TV show I grew up watching, St. Elsewhere, set in a teaching hospital.

Florence Hufnagel (played by the mostly forgotten, but truly awesome, Florence Halop) was a recurring character. She was the classic patient-from-hell that we all encounter during our training (I didn't realize how accurate her portrayal was until I did my residency 10 years later). She was comically abusive and sarcastic, and made you realize how hard it could be to try and take care of someone you couldn't stand.

Her character made such an impression on a generation of TV watchers (and future doctors) that as recently as 2010 she was being cited in the news as an example.

In one of the most memorable scenes in TV history, Mrs. Hufnagel died from a bizarre combination of cardiac surgery complications and (more importantly) a malfunctioning adjustable hospital bed. It folded up into a V shape, bending her in half and suffocating her. Her death scene showed only one arm, sticking straight out the side of the folded bed.

In a bizarre postscript, it later turned out that she'd left her entire estate to one of the residents (Elliot Axelrod). When he met her lawyer it was (roughly) $50,000, but with taxes, funeral costs, and "an ongoing legal action with American Samoa" it left him with something like $18.73.

So, if you really want to think there's a disorder called "Hufnagel's Syndrome," I suppose it would be being killed by an electric adjustable bed.

Thursday, February 16, 2012

A number of studies have addressed withdrawal issues, covering alcohol, tobacco, and controlled drugs. A review of the literature, however, shows a surprising lack of research into other addictions.In an attempt to rectify this situation I'm publishing the following data, addressing a transient, yet debilitating, condition.

For the purposes of assessment, and for possible use in future cases, a grading system was developed for this paper. It was based on the World Objective Zeitgeist Joint Organizational Bureaucratic System (WOZJOBS) staging scale data.

Case report:

A middle-aged neurologist recently left his MacBook Pro overnight at the Apple Store for repairs. Over the next several hours he underwent a gradual series of decompensations, which are presented here.

Stage 3: Decides to go online with iPad. Discovers it was left at the office. Considers 1 hour drive through snow back into dangerous downtown area after dark to get it. Finds that spouse let air out of car tires to prevent this. Hyperventilates.

Stage 4: Tries to use iPhone to send long emails and write blog posts, discovers it's not particularly well suited to this. Sprains thumb.

Stage 5: Desperation. Diaphoretic & dyspneic. Dusts off old Windows laptop in the back of closet and is able to get online. It freezes up every 2-3 minutes, reminding him why he stopped using Windows in the first place. Blames Steve Jobs for his current state of despair. Spouse administers sedative consisting of caffeine-free Diet Coke laced with an old Vicodin tablet from the medicine cabinet.

After being sedated the subject was tucked into bed, carefully guarded by a pair of 4-legged orderlies. All symptoms resolved the following day after picking up the repaired computer.

Discussion: Computer withdrawal blows. They should be able to carry out all repairs in less than one-fourth the estimated time (like Mr. Scott) and not have to keep it overnight. Also, caffeine-free Diet Coke sucks.

Sunday, February 12, 2012

Now, admittedly, my entire campaign thus far is based on one issue, but yesterday while attending a 9-year-old girl's birthday party with my kids, I came up with a second point.

While I strongly support freedom of expression, I also believe some times are better than others to express your beliefs.

So, if elected President, I promise you this:

Any father who shows up at his 9-year daughter's birthday party wearing a T-shirt that says "IT AIN'T GONNA SUCK ITSELF" with an arrow pointing downwards, will be immediately castrated by specially trained fashion police.

Thursday, February 2, 2012

A strange event happened 53 years ago today. And what makes it unusual is that the facts are well-documented. It's the "why?" that may never be known.

Kholat Syakhl is a mountain in the Ural range in Russia. The name is from the language of the local Mansi tribes, and means "Mountain of the Dead."

In early 1959, a group of 9 young men & women set out to ski-trek through the area. It was winter, but all were experienced, well-trained winter skiers. They carried plenty of supplies. All were students, or recent graduates, of Ural State Technical University. The leader of the group was 23 year-old Igor Dyatlov.

Igor Dyatlov

They carried cameras and diaries, which were eventually recovered. The pictures showed routine events in the trek, and were helpful afterward in trying to reconstruct times... up to a point.

They left Vizhai on January 27, 1959, and their pictures suggest the trip went well. They show a group clowning around and enjoying themselves.

On January 31 they climbed into a highland area, and near a clump of trees cached surplus food & equipment for the return leg of their trip.

On February 2 they began hiking through a mountain pass. Their original plan was to get through the area and camp on the opposite side that night, but snow had started to fall. With the visibility worse they headed west by mistake, going upwards on Kholat Syakhl.

They realized the mistake quickly, but by then darkness had started to set in. They decided to make camp in a clearing there, and cross the pass in the morning. They set up camp at around 5:00 p.m., had dinner, and were settled down for the night by 9:00. By all indications it was a fairly typical evening.

Setting up camp.

Dyatlov was planning to send a telegraph home when they returned to Vizhai, on February 12. When it didn't arrive there was little initial reaction, as treks of this sort were known to last a few extra days. But by February 20 enough people were concerned that the first search parties went out. Eventually the police were brought in, and used helicopters to search the area.

On February 26, searchers found their tent on the slopes of Kholat Syakhl. It was badly damaged, and curiously had been cut through from within. The entrance was still clasped closed from the inside.

Outside the ruined tent were footprints heading for the forest. Following them, searchers found the first 2 frozen bodies. Both were under a large tree, near the remains of a fire. They were men, both barefoot and wearing only underwear. Branches of the tree were broken off, and the mens' hands and feet were injured, suggesting they'd tried to climb it.

Three other bodies eventually turned up, spread out between the tent and the tree, in positions suggesting they were returning to the tent when they died. One was Dyatlov, clutching a large tree branch in one hand.

It had been -22°F (-30° C) that night, with blowing snow. Yet, something had happened that drove experienced skiers frantically out, nearly naked, into temperatures that they knew would be fatal in a short time. All were found to have died of hypothermia. Only one body had any sign of injury, a small, non-fatal, skull fracture.

The remaining 4 frozen bodies weren't found until the spring thaw, on May 4. They were in a stream bed a few hundred feet from the tree.

The autopsies of the last 4 added to the mystery. They were wearing more clothes than those found under the tree, but not nearly enough to handle the temperatures (most of the heavy clothing had been left in the remains of the tent). Only one had died of exposure. The other 3 from severe trauma: 1 had massive skull damage, the other 2 had suffered serious chest cavity injuries and broken ribs. One woman had her tongue completely torn out. None of the bodies had any signs of external wounds, and there was no superficial soft tissue damage. This suggested massive, sudden pressure to the affected areas (such as seen in high-speed car accidents).

Based on the amount of food in their stomachs, all had died 6-8 hours after their last meal (between 6:00-7:00 p.m. from the diaries).

All their clothing, and the tent, had varying levels of radiation on them (higher than the area's natural background).

So what happened?

The best that investigators in 1959, and again during a 2nd review of records in the 1990's, came up with is that a "compelling unknown force" occurred between 11:00 and midnight that night.

Something that made 9 highly-experienced winter skiers so desperate to get out of their tent that they cut through it from inside rather than unclasp the entrance, then ran into the freezing night wearing far less than they knew would be needed to survive the weather outside.

From the footprints they ran in all directions initially, then regrouped and built a fire under the tree. At that point they tried to share clothing for warmth (based on what different bodies were wearing). They were only 1500 feet from the tent and all of their supplies, but, because of whatever had happened, didn't want to go back.

At some point 2 of them died of exposure, which is likely when Dyatlov and 2 others headed back to the tent. They never made it.

In the next few hours the remaining 4 left the fire, and decided that heading farther into the forest was safer than going back to their supplies and the tent. During the night they reached a frozen stream bed, where something caused serious bodily injuries to 3 of them.

And the "compelling force?"

There were suspicions that local Mansi tribes had attacked the group, but no other footprints (human or animal), or even evidence of a struggle, were ever found. There was no evidence of gun or knife wounds. In addition, all their food and other supplies were untouched. Tribesmen would likely have taken anything of use. Animals, such as bears, would have eaten the exposed food in the tent (not to mention the bodies).

Some suggest they were startled by an avalanche, but there was no evidence of one, even minor, in the area.

Another theory (and still the most persistent) is that they were accidental victims of a Soviet secret weapons test in the area, though again, no evidence to confirm this has ever come to light, even with files re-opened in the 1990's.

Inevitably, UFO's are blamed. A group of hikers 32 miles south of Kholat Syakhl that night had reported seeing "orange spheres" in the sky. Similar sightings were also reported by a meteorological station in the area, before the disappearance of the hikers was known. But this is hardly enough to draw conclusions from. I, personally, am very skeptical of paranormal claims, UFO's, etc. And don't even get me started on cryptids.

The bottom line is that the "compelling unknown force" was known only to 9 people, and none came home to tell the tale.

After the incident the area was closed off for 3 years. Today it's named Dyatlov Pass, in memory of the group. Nothing unusual has happened there again.

Something took the lives of 9 young men and women 52 years ago today. It remains a complete mystery. And likely always will be.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.